Chest
Volume 127, Issue 5, May 2005, Pages 1531-1536
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Clinical Investigations
Pulmonary Hemodynamics in Advanced COPD Candidates for Lung Volume Reduction Surgery or Lung Transplantation

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Study objectives

To assess the pulmonary hemodynamic characteristics in COPD candidates for lung volume reduction surgery (LVRS) or lung transplantation (LT).

Design

Retrospective study.

Setting

One center in France.

Patients

Two hundred fifteen patients with severe COPD who underwent right-heart catheterization before LVRS or LT.

Results

Mean age was 54.6 years. Pulmonary function test results were as follows: FEV1, 24.3% predicted; total lung capacity, 128.3% predicted; residual volume, 259.7% predicted. Mean pulmonary artery pressure (PAPm) was 26.9 mm Hg. Pulmonary hypertension (PAPm > 25 mm Hg) was present in 50.2% and was moderate (PAPm, 35 to 45 mm Hg) or severe (PAPm > 45 mm Hg) in 9.8% and in 3.7% of patients, respectively. Cardiac index was low normal. PAPm was related to Pao2 and alveolar-arterial oxygen gradient in multivariate analysis. Cluster analysis identified a subgroup of atypical patients (n = 16, 7.4%) characterized by moderate impairment of the pulmonary mechanics (mean FEV1, 48.5%) contrasting with high level of pulmonary artery pressure (PAPm, 39.8 mm Hg), and severe hypoxemia (mean Pao2, 46.2 mm Hg).

Conclusion

While pulmonary hypertension is observed in half of the COPD patients with advanced disease, moderate-to-severe pulmonary hypertension is not a rare event in these patients. We individualized a subgroup of patients presenting with a predominant vascular disease that could potentially benefit from vasodilators.

Section snippets

Materials and Methods

All COPD patients referred to our center for consideration of either LT or LVRS from 1988 to 2002 and who underwent right-heart catheterization were screened for potential inclusion in the study. Right-heart catheterization is not performed routinely for COPD but is a mandatory component of a thorough cardiorespiratory assessment before LT or LVRS.

Patients were excluded if a factor that could influence pulmonary hemodynamics was present. In particular, the exclusion criteria were as follows:

Characteristics of the Studied Population

Two hundred forty-seven patients fulfilled the selection criteria for the study. Although they had no evidence of cardiac dysfunction, 32 patients with a Pw > 15 mm Hg were excluded from the analysis because pulmonary hypertension, when present, has a postcapillary component. Thus, 215 patients form the basis of this study.

In this cohort, pulmonary hemodynamics was assessed as a preoperative evaluation before LVRS in 123 patients and before LT in 92 patients. The demographic and respiratory

Discussion

The salient results of our study are the following: (1) while half of the patients with severe COPD had mild-to-moderate pulmonary hypertension, a subset of patients (3.7%) exhibit severe pulmonary hypertension; and (2) we identified a subgroup of patients characterized by a moderate impairment of the pulmonary mechanics contrasting with the severity of pulmonary hypertension.

Pulmonary hypertension is a well-known complication of COPD. Its presence is associated with a worse survival11 and an

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